Waiting for today...: February 2014

Thursday, February 27

Putting the Pieces Together: Where I Am, Part 1

“Depression” (2).  Could I be depressed?  Yup, still in denial.  I haven’t lost all enjoyment in activities that I’ve found pleasure in.  However, I do hesitate doing them… I haven’t referred to other activities, especially those of daily living.  I, at times, will go days without a shower.  I only brush well enough to neutralize the taste of bad breath.  I’ll only wash my clothes when I’ve run out of clean underwear but I’ll live out of my laundry bag until I have to wash again...  My things are scattered all over the living room, I don’t wash my dishes and I’ll only take the trash out when it starts to smell.  This is not a constant however… ~ December 2005
… my mood
It has improved significantly as the holidays have passed.  The hallmarks of my depression from 2005 until now have been the same, so I know I’m better: I’ve been consistent with my hygiene, eating a bit better and chipping away at cleaning my apartment one corner at a time.  I’ve also been a bit more social and putting more energy into some of the things that I enjoy.  I am nowhere close to what would be 100% for me.  But I’m moving in that direction.  And although I still feel stuck in the vicious cycle, I’m thankful for the progress I’ve made: no longer in denial, now in treatment, committed to honestly seeking my root issues.  And, as my mood continues to lift, I would like to explore more ways to keep my mood stable.
… my treatment
Since initiating therapy, I have reduced the frequency of my visits to once every two weeks.  Thankfully, my relationship with my therapist has improved.  In addition to being uneasy about baring my soul to a complete stranger, the “intake” appointment did little to spurn those feelings.  The process was rushed, impersonal and without warning. Another bitter moment occurred during one of our initial conversations when, in response to a statement I made about reaching out for help, she snapped back at me the fact that I first needed to help myself.  I almost lost it.  My response was something to the effect of, “if I knew what to do I wouldn’t be here!”.  Unfortunately that set the tone for the next month or so.  A short while before the holidays, however, I noticed we were getting in sync.  And now I look forward to our sessions.   
I always thought of myself as introspective.  But as I progressed in therapy, I realized that there was so much I was missing.  Prior to therapy, I came to realize that I am sensitive, socially awkward, have a fear of forming deeper relationships and I hold a lot of resentment.  Therapy has helped me to recognize the thread connecting them all: rejection.  I have been rejected since I was in my mother’s womb and the perception of rejection haunts me today. Now that it has been identified, I have to go about the task of meticulously uprooting it.  I knew it would be a painfully overwhelming process with the potential to make my depression worse or cause me to retreat into denial.  I was encouraged to take medication when I first saw my therapist but I wanted no parts of that conversation at the time. She then asked, “aren’t you tired?”, and I was at a loss for words.  Realizing the enormity of this journey and after a conversation with a close friend who once shared my adamancy against medication therapy, I swiftly reconsidered my position.  

The “ups and downs” I often used to describe my life was actually mood swings according to my new doctor, a psychiatrist.  She recommended Lamictal for a mood stabilizer.  Because of the rare but fatal side effect of Steven-Johnsons syndrome, my dose began at 25mg and was slowly tapered up to 100 mg daily.  Thankfully, I had no side effects.  Actually, there didn’t seem to be any effects at all.  I would later ask to discontinue it but my psychiatrist did not recommended it.  She instead added an antidepressant, Celexa and explained that because I may have bipolar features there was a risk of exacerbating symptoms of mania.  A few weeks after starting Celexa at 10 mg, I noticed my mood lifting but not dramatically as in the past.  Recently increased to 20mg, as I am still mildly depressed and erratically irritable, my hope is that I will see greater improvement in the next few weeks.


Saturday, February 22

Breaking Down

con't from: Out of the Fire?

Usually depressed during the holidays, my mood was much improved before the 2013 New Year.   One job, not at the bedside, meant less stress.  I still had a lot to learn in my new position, there was minimal improvement in my hours and there was the added task of relocating to another neighborhood.  Yet, I had a two month period of normalcy.  My depression resurfaced from time to time but it was not as severe as in the past.  I attribute a great deal of this to my faith.  

After obeying the gospel and as I grew in faith, I replaced mal-coping mechanisms with spiritual activities.  These activities included reading and studying scripture, prayer, singing hymns and talking about the goodness of the Lord with other members.  All these helped me to navigate difficult times related to my mood, whereas the mal-coping was a mere distraction.  I knew that as a Christian I was not exempt from depression, just as I am not exempt from diabetes or heart disease.  I indeed became depressed on occasion.  However, with my new found faith, I felt strengthened to pick up the pieces as my mood would lift. And I no longer felt hopeless.

I would continue to ride that tide until the summer.  After the congregation split, I felt worse than I ever had since I was diagnosed back in 2003.  This time hopelessness was met with confusion.  When I sought the comfort of members they seemed to be more interested in getting me to agree with their point of view.  The result was painful isolation. Although so many others left, I eventually decided that it was in my best interest to stay and see things through.  But as the dust settled I realized that the damage was done.  I found myself once again in a dark place; my confidence in Christians having waned again and I was drained of all motivation to walk a life worthy of the faith.  

I no longer participated in spiritual activities, personal or congregational, consistent enough to keep me steady.  But even in light of the crisis I was having, I didn’t return to the familiar mal-coping mechanisms I vowed to put behind me. Ordinarily this would be a proud declaration, but the result was no coping at all.  While I was at home, I was left to my own self-destruction but I felt safe.   On the other hand, when I had to walk out my front door I found myself constantly on edge.  

At work I was most miserable, irritable and impulsive, feeling as though I was not in control of myself.  I was short tempered and everything seemed to frustrate me.   I would walk with my head down as to avoid having to converse with people, not knowing when I would explode. The day my frustration peaked I had to work my scheduled five hour shift, one of a consecutive number of days in which I preferred to remain isolated.  As soon as I walked into the door my anger turned to anxiety.  My mind raced, I was visibly agitated, afraid and I just wanted the pressure to go away. I was tired of the misery.  

Although I wanted to run for the exit doors, I didn't.  After receiving encouragement from my colleague, I calmed myself as best as I could and made an emergency appointment to see my doctor instead.

Was I ecstatic to turn 35? I would like to say “yes” and not have to force a smile. I was excited to read my letter…was excited to see mom… was excited to experience my first cruise. But I was most excited to escape my life. A month or so ago I found myself in the midst of the worse low I’ve had since college. You remember that day? When I called my professor on the last day of clinical and told her that I wasn’t coming? Just like that moment, I didn’t have an out. Denial was no longer an option. I had to find and face whatever it was that kept me in this cycle of ups and downs. I had to face me, everything that I tried to hide from others and from myself, for years. By the time the opportunity came to escape my life, that is to take a vacation, I was already three sessions into much-needed-since-forever-ago therapy… ~ November, 2013

Monday, February 17

Found & Lost...

May 23rd, 2011… Four years earlier I considered myself “godless”.  I had put my faith in Jesus Christ the Messiah near the age of twelve.   Or so I thought.   Years later I found that I had actually put my faith in people and by then, it was too late.  To my spirits disadvantage, my faith grew immensely until it failed. Because when people let me down I walked away from everything that had sustained me up to that point in my life including the Messiah. These events unfolded over the span of a few years. And in time, I learned to put my faith in myself.
“Show Me Thy Faith…” When I finally came into my own I found that I was also at the lowest point in my life.  I was away from friends and family and I felt alone.  I needed something to hold onto to keep from losing myself completely to the harshness of this world.  Bad decisions soon followed.  I abused myself, allowed myself to be used and my relationships suffered.   The faith that I had proudly put in myself failed as well.  And in a moment in which I could’ve lost everything, I cried out to a God that I wasn't sure existed. Desperate  Broken.
“Peace, Be Still...” Peace shook me from my sleep after I prayed that evening.  In the midst of an actual thunderstorm, a sure foundation truth was brought to my remembrance: my faith in Jesus Christ never once failed me.  People fail… Self fails… God does not.  And while my curtains flew about frantically, and drops of rain spattered on my window sill; while the thunder rolled and the lightning cracked, I realized that I was never truly alone.  Although I had given up on Jesus and fled from His presence, He never gave up on me or left me destitute.  So I was back… to square one.  And I didn't even know where that was.
“Planted on Good Ground...”  I had come to know Jesus Christ through my relationship with other believers.  Yet, it was not until the Word of God was rightly divided for me on May 23rd 2011 that I realized that I didn't know enough to save my soul.  On that day, I heard the truth for the first time in all the years that I believed.  I came to believe for the first time, on that day, that Jesus Christ is all that He declares to be. After I confessed that Jesus is the Christ, I submitted to a water baptism and when I arose I knew I was different.  All the years of being a believer brought me to Christ but now I knew that I had been saved by Christ and I finally felt empowered to live…--December 16th, 2012
That is of course up until the summer of 2013.  That June, the congregation I joined myself to after I obeyed the gospel found itself divided.  The division was the result of the elders’ decision to release our full-time preacher. Perhaps a more accurate statement would be that it was the way in which he was released that turned half of the congregation away.  No matter the reason, I was stuck in the middle of the tug of war that ensued between sides.  I felt as though no one considered the spiritual fragility of the new converts or any other member that may have been weak in the faith at the time.  Still a babe in Christ, for me the result was a shaken faith.  There I was thinking I finally found hope to overcome the struggles that plagued me over the years of my adult life.  Instead I was forced to realize that I would have to suffer yet another spiritual setback.

Wednesday, February 12

Out of the Fire?

From a very young age I knew I wanted to be in the medical field.  That is, if I were to choose college over the ARMY after high school.  As a kid I thought I wanted to be a doctor.  My grades were poor in middle school and high school so I had no choice but to deflate my “what-do-you-want-to-be-when-you-grow-up” balloon.  It was my best friend that suggested the field of nursing.  After doing my research, I decided to go for it.  I took as many pre-requisites as I could at a community college before enrolling in a nursing program.  It was in my junior year of college when, while working at a nursing home, I realized exactly what I would do with my nursing career.  

While my classmates opted for specialty areas like labor-delivery and cardiac, I wanted to work to help improve the care of elderly in the community.  I and others chose to begin our careers on a medical-surgical unit to learn a range of foundational nursing skills that could only be gained at the bedside.  To a great extent, the patient demographic on my unit was elderly.   Caring for them in an acute care setting, however, posed both professional and personal challenges.  Because of this, I had come to realize my days on the unit were numbered.

Yet, I continued to do the best I could.  Each day I would make slight changes to my routine in hopes to improve the care my patients received.  But, it was all for naught.  By this time it had been five years at the bedside and I felt as though I was approaching a glass ceiling. After a few patient complaints, I realized I had done all I could and it was now time to revisit my career path.  Once and for all, I threw caution to the wind and decided to step away from bedside nursing in the summer of 2012.   
The community hospital that gave me my first nursing position was set to relocate to a brand new 160 bed facility.  I knew that all departments would need to hire additional staff to accommodate the increase in demand and so I applied for the posted part time position in case management.  Sometime after the move but before training began, I decided to cut my hours on the unit.  I made the decision with perfect timing because my part-time hours in case management would quickly swell to full time hours although my “status” as a part-timer would remain the same.  During this period, my depression waxed and waned but my anxiety was a constant.
The obvious root of my increased anxiety was directly related to my new role: different responsibilities, the need for an expanded knowledge base and a whole other set of personalities.  I admit, I was intimidated and my difficulties with communication put my anxiety and frustration on display.   In the past, frustration paired with my lack of confidence would eventually manifest itself in the form of passive-aggressiveness.  I didn’t want these behavioral issues to carry over into my new position.   So, I continuously reminded myself often that no matter how difficult the transition was, I indeed made the right decision.
A couple of months passed and I decided to further cut my hours on the unit.  Not long after, I left the unit all together.  With this decision I saw an opportunity to accelerate my understanding of the field thereby increasing my performance in my new role in hopes to also increase my confidence.  I had some success.  However, from day to day and week to week my hours fluctuated.  I soon began to blame the inconsistent hours for the fluctuations in my mood, just as I blamed bedside nursing.  However, with the exception of a few very overwhelming days, I managed to leave most of my increasing and seemingly random frustrations at the door.

next in series: Breaking Down

Friday, February 7

A Challenging Transition, Part 2

I could no longer afford to pay my bills with my revamped income but I couldn't bring myself to make another phone call home.  Instead, I applied for cash advance loans every two weeks like clockwork to supplement my income.  It would be three months before I could sit for the boards again.  To prepare, I enrolled in a mandatory study course paid for by my employer.  Having nursing knowledge without the ability to apply that knowledge to clinical situations presented in the NCLEX is a sure way to fail the exam.  The core curriculum of the Kaplan course helps eligible nurse applicants to understand the complex structure of the exam questions, thereby increasing their ability to identify the most appropriate answers.   On June 8th 2007, I passed the NCLEX.  The license verification was proof of what I already knew.  On that following week I received more great news: my orientation on the floor would be extended.
My first experience with a full assignment happened to be the last day of orientation and that day ended in tears. I was ill prepared going into subsequent shifts on my lonesome. I would continue to have days like that last day and worse.  My frustration soon turned into anger.  I would wake up angry prior to going into work and leave angry at the end of the day.  My speech and my behavior at work reflected my anger and frustration, eventually rubbing my colleagues the wrong way.  I would control myself long enough to express my concerns in a civilized manner but to no avail which further fueled my anger.  I was a new nurse, drowning in the stress that accompanies bedside nursing and it seemed as if no one cared.  On my days off my anger would melt into depression.  Because I was afraid to be vulnerable, I felt I had no other choice than to wallow in the darkness.  
Every shift came complete with a continuous game of tug-of-war between me and prioritization.  As I struggled to be mindful of my time management, I was also overwhelmed by the thought of giving less than quality care.  I began to question my choice to become a nurse.  I thought about all of the years wasted preparing to enter into a profession that didn't seem to be a right fit for me.  I knew that if I were to continue on in this field, something had to change.  I didn't know if I just longed to be home or if nursing would somehow be less of a stressor as long as my friends and family were closer.  In a twisted state of delusion, forgetting why I chose to relocate in the first place, the answer appeared to be “yes” and “yes”.
I was homesick and returning home seemed to be the answer to all my troubles at the time.   The return home would be delayed, however.  I was less than two years into a three year contract.  In the interim, I searched and applied for jobs, applied for a temporary PA nursing license and explored prospective residential areas outside the city of Philadelphia.  Because of the ongoing nursing shortage, I was sure that someone would hire me.  I was so sure that I almost relocated prior to gaining employment.  Thankfully “almost”; in the end I would not relocate after all.  The year I planned to relocate was two years after the economic recession and the marketplace was unforgiving, even to nurses.  

With no hope of returning home in the near future, I sought other ways to escape the bedside.  And then a funny thing happened.  A few changes at work made my time on the unit more tolerable.  A new manager, slight staff turnover and an improved nurse-to-patient ratio helped me to improve my time management and prioritization skills subsequently reducing my stress.  I actually liked Virginia Beach!  I still struggled with anger and depression but my new life seemed to be getting better.  I finally started to see and enjoy what I had been fighting so hard for.

next in series: Out of the Fire?

Sunday, February 2


“Feels like the world is closing on me...  I keep on slippin' deeper into myself, 
and I'm scared…”

At 23 years old, I hadn't done well in high school, I was from a lower class one parent household and still I was accepted into the nursing program at a four year university.  Due to the shifty encouragement I received as I entered community college years earlier, it was more than an opportunity to better my future.  It was also an opportunity to prove my critics wrong.  However, just as in high school, I barely stepped up to the challenge.  I did graduate, but it  was late and with a 2.52 grade point average.  I really hoped that after graduation... after the move, I would rise above all my past disappointments...

Ever since I moved back to the states as a school age child music has played a huge role in my life. In the late eighties, Michael Jackson, Madonna, the hair bands and hip hop grabbed my attention as my home in the islands did not have cable television.   Music helped me through that transition, from elementary school to high school, from college to the working world. You name it music has helped me cope through it.  When the world seems to be crumbling down around me, music helps me to escape.